Abstract

Background: Lack of updated and uniform medication lists poses a problem for the continuity in patient care. The aim of this study was
to estimate whether hospitals succeed in making accurate medication lists congruent with patients’ actual medication use.
Subsequently, the authors evaluated where errors were introduced and the possible implications of incongruent medication lists.

Methods: Patients were visited within one week after discharge from surgical or medical department and interviewed about their use
of prescription-only medication (POM). Stored drugs were inspected. Medication lists in hospital files and discharge letters
were compared with the list obtained during the interview. The frequency of incorrect medication use and the potential consequences
were estimated.

Results: A total of 83 surgical and 117 medical patients were included (n = 200), 139 patients (70%) were women. Median age was 75
years. Six patients stored no POM, 194 patients stored 1189 POM. Among the 955 currently-used POM, 749 POM (78%) were registered
at some point during hospitalisation but only 444 (46%) were registered in discharge letters. 66 POM users had no medication
list in their discharge letter. Local treatments (skin, eyes, airways) were registered less frequently than drugs administered
orally. In total, 179 of the currently-used POM (19%) were not mentioned anywhere in hospital files, probably because of insufficient
medication lists made at admission, and the prescribed regimen was unclear. At least 63 POM (7% of currently-used POM) were
used in disagreement with the prescribed regimen.

Discussion: Approximately one fifth of used POM is unknown to the hospital and only half of used POM registered in discharge letters.
Insufficient medication lists hamper clarifying whether or not patients use medication according to prescription. In order
to prevent medication errors a systematic follow-up after discharge focusing on making an updated medication list might be
needed.